Provider Demographics
NPI:1104463629
Name:LAMB, MATTHEW SHEPHERD (LMHC-P)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:SHEPHERD
Last Name:LAMB
Suffix:
Gender:M
Credentials:LMHC-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 34223
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99803-4223
Mailing Address - Country:US
Mailing Address - Phone:585-729-3000
Mailing Address - Fax:
Practice Address - Street 1:8585 OLD DAIRY RD STE 203
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-8094
Practice Address - Country:US
Practice Address - Phone:585-729-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-03
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK201662101YM0800X
NY103395101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1104463629Medicaid